가바펜틴에 의한 스티븐스-존슨 증후군

마정은 ( Jeong Eun Ma ),김현식 ( Hyun Sik Kim ),박동준 ( Dong Jun Park ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ),정이영 ( Yi Yeong Jeong ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.4

Stevens-Johnson syndrome (SJS) is a severe, diffuse mucocutaneous eruption causing erythematous or purpuric macules, blisters, target lesions. Other manifestations include fever and mucosal lesions (stomatitis, conjunctivitis, or urethral inflammation) accompanied by at least one other visceral organ, such as hepatic, renal or gastrointestinal involvement. SJS is essentially a drug-induced disease and common causative agents include antibacterial sulfonamides, anticonvulsant agents, nonsteroidal anti-inflammatory drugs and allopurinol. Gabapentin is usually considered to be a safe agent for patients with a previous history of drug allergies and there are rare cases of SJS induced by gabapentin. We experienced a 68-year-old woman who developed whole body mucosal erosions with widespread erythematous maculopapular skin rashes after ingestion of gabapentin. After discontinuation of gabapentin and use of systemic steroids, symptoms, signs and laboratory findings gradually improved. We report a case of SJS diagnosed by characteristic clinical findings with a brief review of the literature. (Korean J Asthma Allergy Clin Immunol 2007;27:283-286)

안정된 만성 폐쇄성 폐질환환자와 급성 악화상태의 혈중 Osteopontin 농도 비교

마정은 ( Jeong Eun Ma ),이승훈 ( Seung Hun Lee ),김유은 ( Yu Eun Kim ),임수진 ( Su Jin Lim ),이승준 ( Seung Jun Lee ),정이영 ( Yi Yeong Jeong ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deog Lee ),황영실 ( Young Sil Hwang ),조유지 ( Y 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.3

Background: Osteopontin (Opn) is recognized as an important adhesive bone matrix protein and a key cytokine involved in immune cell recruitment and tissue repair and remolding. However, serum levels of osteopontin have not been evaluated in patients with chronic obstructive pulmonary disease (COPD). Thus, the aim of this study was to evaluate and compare the serum levels of osteopontin in patients experiencing COPD exacerbations and in patients with stable COPD. Methods: Serum samples were obtained from 22 healthy control subjects, 18 stable COPD patients, and 15 COPD with exacerbation patients. Serum concentrations of osteopontin were measured by the ELISA method. Results: Serum levels of osteopontin were higher in patients with acute exacerbation than with stable COPD and in healthy control subjects (62.4±51.9 ng/mL, 36.9±11.1 ng/mL, 30±11 ng/mL, test for trend p=0.003). In the patients with COPD exacerbation, the osteopontin levels when the patient was discharged from the hospital tended to decrease compared to those at admission (45±52.1 ng/mL, 62.4±51.9 ng/mL, p=0.160). Osteopontin levels significantly increased according to patient factors, including never-smoker, ex-smoker and current smoker (23±5.7 ng/mL, 35.5±17.6 ng/mL, 58.6±47.8 ng/mL, test for trend p=0.006). Also, osteopontin levels showed a significantly negative correlation with forced expiratory volume in one second (FEV1%) predicted in healthy controls and stable COPD patients (r=?0.389; p=0.013). C-reactive protein (CRP) was positively correlated with osteopontin levels in patients with COPD exacerbation (r=0.775; p=0.002). Conclusion: The serum levels of osteopontin increased in patients with COPD exacerbation and tended to decrease after clinical improvement. These results suggest the possible role of osteopontin as a biomarker of acute exacerbation of COPD.

결핵균과 비결핵성항산균 검출에 Real-time PCR의 유용성

윤은영 ( Eun Young Yun ),조수희 ( Su Hee Cho ),고세일 ( Se Il Go ),백종하 ( Jong Ha Baek ),김유은 ( You Eun Kim ),마정은 ( Jeong Eun Ma ),이기동 ( Gi Dong Lee ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),김호철 ( Ho Cheol Kim 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.4

Background: The purpose of this study was to evaluate recently developed real-time polymerase chain reaction (PCR) assay kit to detect Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM) in respiratory specimens. Methods: We assessed the positive rate of the real-time PCR assay to detect MTB and NTM in 87 culture-positive specimens (37 sputum, 50 bronchial washing), which were performed real-time PCR by using Real-QTM MTB&NTM Kit from January 2009 to June 2009, at Gyeongsang University Hospital. To compare the efficacy with the TB-PCR assay, we evaluated 63 culture-positive specimens (19 sputum, 44 bronchial washing) for MTB or NTM, which were performed TB-PCR by using ABSOLUTETM MTB II PCR Kit from March 2008 to August 2008. Results: Among 87 specimens tested using real-time PCR, MTB and NTM were cultured in 58 and 29, respectively. The positive rate of real-time PCR assay to detect MTB was 71% (22/31) and 92.6% (25/27) in AFB stain-negative and stain-positive specimens. For NTM, the positive rate of real-time PCR was 11.1% (2/18) and 72.7% (8/11) in AFB stain-negative and stain-positive specimens. Among 63 specimens performed using TB-PCR, MTB and NTM were cultured in 46 and 17, respectively. The positive rate of TB-PCR was 61.7% (21/34) and 100% (12/12) in AFB stain-negative and stain-positive specimens. TB-PCR was negative in all NTM-cultured 17 specimens. Conclusion: TB/NTM real-time PCR assay is useful to differentiate MTB and NTM in AFB stain-positive respiratory specimens and it is as effective in detecting MTB with TB-PCR.

일차진료의에서의 흡입기구 사용 숙련도 현황

정재원 ( Jae Won Jeong ),장윤석 ( Yoon Seok Chang ),김철우 ( Cheol Woo Kim ),김태범 ( Tae Bum Kim ),김상헌 ( Sang Heon Kim ),권용은 ( Yong Eun Kwon ),강혜련 ( Hye Ryun Kang ),정이영 ( Yi Young Jeong ),박중원 ( Jung Won Park ),지 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.2

Background: For the optimal asthma management, health-care professionals (HCPs) should properly educate patients in skills in using inhalers. Objective: To evaluate the skillfulness of primary care physicians (PCPs) in the use of inhalers (pressurized metered dose inhaler [pMDI], turbuhaler and diskus) commonly used for asthma treatment. Method: We evaluated a total of 133 PCPs who attended the instruction program for their techniques for using 3 different inhaler devices. Participants completed each step for using inhalers and overall performance was classified as good, adequate and inadequate. The current educations in the use of inhalers to their patients were also assessed. Result: The overall performance was inadequate in 64.7%of the patients using a pMDI, 79.7% of the patients using a turbuhaler and 52.6% of the patients using a diskus. However, 91 PCPs (68.4%) reported that they educated their patients in inhaler techniques. Three and more exposures to the course training in using inhalers were significantly associated with appropriate inhaler techniques in turbuhaler(P=0.018) and diskus (P=0.0002).Conclusion: The skillfulness of PCPs in the use of inhalers was not enough to educate asthmatics. Therefore it is mandatory to develop and implement the effective instruction programs for HCPs in the primary care field. (Korean J Asthma Allergy Clin Immunol 2011;31:116-123)

우중엽증후군의 원인 -최근 수년간 지역 3차 병원의 경험-

김현옥 ( Hyun Ok Kim ),마정은 ( Jeong Eun Ma ),이승준 ( Seung Jun Lee ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),전경녀 ( Kyoung Nyeo Jeon ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.3

배경: 우중엽증후군은 반복적이고 만성적인 우중엽의 허탈을 나타내는 질환으로 그 원인은 매우 다양하다. 최근 국내에서 우중엽증후군의 원인에 대한 발표는 부족한 실정이어서 저자들은 최근 수년간 지역 3차 병원에서 경험한 우중엽증후군의 원인과 임상적 특징을 알아보고자 하였다. 방법: 2003년 1월부터 2006년 7월까지 경상대학교 병원에 내원하여 흉부 단순촬영 또는 전산화 단층촬영에서 우중엽증후군이 의심되어 기관지내시경 검사를 시행한 88명의 환자(남:여=22:64, 평균연령: 67.2±10.3)를 대상으로 그 원인과 임상적 특징을 후향적으로 조사하였다. 결과: 1) 여자가 64예(72.7%)로 남자보다 많았고 연령별 빈도에서 65세 이상의 고령환자가 58예로 65.9%를 차지하였다. 2) 임상 증상은 기침이 30예(34.1%)로 가장 흔하게 나타났고, 호흡곤란 21예(23.9%), 객담 15예(17.0%), 객혈 11예(12.5%), 흉부통증과 전신 쇠약감이 각각 5예(5.7%)에서 나타났으며, 증상이 없이 우연히 발견된 경우가 8예(9.1%)였다. 3) 흉부 방사선 촬영에서는 무기폐 49예(55.7%), 폐경화 43예(48.9%), 종괴 4예(4.5%) 소견을 보였다. 4) 기관지내시경 검사 소견에서 충혈을 동반한 점막 부종 38예(43.2%), 탄분증을 동반한 점막 부종 16예(18.2%), 점액 매복(mucus impaction) 13예(14.8%), 섬유성 협착 10예(11.4%), 종괴 8예(9.1%), 삼출성 조직 괴사 4예(4.5%), 외인성 압박에 의한 협착 2예(2.3%), 정상 12예(13.6%)로 나타났다. 5) 원인 질환은 결핵이 23예(26.1%, 기관지 결핵 22예, 폐결핵 1예)로 가장 많았고, 염증성 변화에 의한 양성 협착 22예(25%), 탄분섬유화증 13예(14.8%), 폐렴 11예(12.5%), 폐암 10예(11.4%), 점액 매복 3예(3.4%), 기관지 확장증 2예(2.3%), 특별한 이상이 발견되지 않은 경우가 7예(8.0%)이었다. 결론: 본 연구에서 우중엽증후군은 65세 이상의 환자에서 흔하게 관찰되었으며, 원인은 대부분 양성 질환이었고, 그 중 기관지 결핵이 가장 흔한 원인이었다. Background: Right middle lobe syndrome (RMLS) is defined as transient or chronic and recurrent atelectasis of the right middle lobe. Although numerous conditions are associated with RMLS, there are very few recent reports in Korea. This study evaluated the causes of RMLS in a local tertiary hospitalover a period of 42 months. Method: Eighty-eight patients (M:F=64:22, mean age: 67.2±10.3 years), who had consistent chest radiography findings and underwent bronchoscopy in Gyeongsang University Hospital from January 2003 to July 2006, were enrolled in this study. The clinical characteristics and causes of RMLS in these patients were retrospectively reviewed. Results: The most common symptoms fo RMLS were cough, dyspnea and sputum. Tuberculosis was the most common cause (endobronchial tuberculosis in 22 and pulmonary tuberculosis in 1) The other causes were bronchial stenosis by benign fibrotic changes in 22 cases (25%), anthracofibrosis in 13 cases (14.8%), pneumonia in 11 cases (12.5%), lung cancer in 10 cases (11.4%), mucus impaction in 3 cases (3.4%), bronchiectasis in 2 cases (2.3%) and no demonstrable causes in 7 cases (8%). The bronchoscopy findings were mucosal edema with hyperemic changes in 38 cases (43.2%), mucosal edema with anthracotic pigmentation in 16 cases (18.2%), mucus impaction in 13 cases (14.8%), fibrotic stenosis in 13 cases (14.8%), a mass like lesion in 8 cases (9.1%), exudative necrotic material in 4 cases (4.5%), narrowing as a result of extrinsic compression in 2 cases (2.3%) and no demonstrable abnormalities in 12 cases (13.6%). Conclusion: Right middle lobe syndrome was observed more frequently in patients over the age of 65. The causes were mainly benign diseases with endobronchial tuberculosis being the most common. (Tuberc Respir Dis 2007; 62: 192-196)

만성 폐쇄성 폐질환 평가 테스트의 유용성

김유은 ( Yu Eun Kim ),이상수 ( Sang Su Lee ),김차영 ( Cha Young Kim ),이승훈 ( Seung Hun Lee ),임수진 ( Su Jin Lim ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),김호철 ( Ho Cheol Kim ),황영실 ( Young Sil Hwang ),이종덕 ( Jong D 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.4

Background: A chronic obstructive pulmonary disease (COPD) assessment test (CAT) has recently been developed as a short and simple method for assessing the quality of life in COPD patients. The object of this study was to assess the usefulness of the Korean version of the CAT for assessing COPD patients in an outpatient clinic. Methods: The study included 60 COPD patients in a stable state from an outpatient clinic. The authors investigated the frequency of acute exacerbation during aprevious year through reviewing medical records. We evaluated the spirometry test, a 6-min walk distance test, and obtained the MMRC dyspnea scale, the Korean version of the CAT, and the BODE index at the time of visit. To assess the usefulness of the CAT, correlations between the CAT and other methods were evaluated. Results: The mean age of patients was 68.3±8.6 years and 95% of patients were male. There was a significant correlation between the CAT score and FEV1% (r=?0.323, p=0.012), the frequency of acute exacerbation (r=0.292, p=0.024), the MMRC dyspnea scale (r=0.554, p<0.001), the BODE index (r=0.380, p=0.003), and 6 MWD (r= ?0.372, p=0.004). The mean CAT score increased according to the GOLD stage (stage 1, 10.7±4.5; stage 2, 13.1±7.9; stage 3, 16.3±6.2; stage 4, 16.5±14.8; p=0.746). Conclusion: The CAT was shown to be useful for the assessment of COPD severity. Therefore, the CAT is an easily applied and simple method for assessing COPD severity in an outpatient clinic.

디클로페낙 소디움 근주에 의해 합병된 양측성 급성 신피질 괴사 1예

윤지철 ( Ji Chul Yun ),백주은 ( Joo Eun Baek ),정은영 ( Eun Young Jung ),이동원 ( Dong Won Lee ),정이영 ( Yi Yeong Jeong ),장세호 ( Se Ho Chang ),이종덕 ( Jong Deog Lee ),김현정 ( Hyun Jung Kim ),박동준 ( Dong Jun Park ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.2

당뇨 환자에서 진단된 대량 객혈을 보인 폐 모균증

조유지 ( Yu Ji Cho ),강명희 ( Myoung Hee Kang ),김현식 ( Hyeon Sik Kim ),정이영 ( Yi Yeong Jeong ),장인석 ( In Seok Jang ),김호철 ( Ho Cheol Kim ),황영실 ( Young Sil Hwang ),이종덕 ( Jong Deog Lee ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.6

Pulmonary mucormycosis is an uncommon, serious opportunistic infection caused by fungi belonging to the order Mucorales and it occurs exclusively in debilitated or immuno-compromised hosts. It is known that the fungi can invade the blood vessels and cause serious ischemic necrosis and bleeding5. We experienced a fatal case of pulmonary mucormycosis in a diabetic 75-year-old man who developed a progressive necrotizing lesion despite administering proper and prompt medical and surgical treatment. We report here on this case along with a review of the relevant medical literature.

기관지내 아스페르길루스종으로 오인된 폐암

함현석 ( Hyun Seok Ham ),이승준 ( Seung Jun Lee ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),전경녀 ( Kyoung Nyeo Jeon ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.2

A 70-year-old man was referred to the department of pulmonology due to blood tinged sputum and an abnormal chest X-ray. The chest X-ray and CT scans revealed a lobulated contour mass-like lesion in the left upper lung field. The bronchoscopic examination showed a whitish and polypoid mass occluding the left upper lobe bronchus. A biopsy specimen from the lesion revealed many aspergillus hyphae. Intravenous and oral itraconozole were administered over a 4 weeks period. Several months later, the size of the mass on chest X-ray increased and a percutaneous lung biopsy revealed a sarcomatoid carcinoma. We reported a case of lung cancer that was obscured by an endobronchial aspergilloma with a review of the relevant literature. (Tuberc Respir Dis 2006; 61: 157-161)

기계 환기가 요구된 중증 지역사회 획득 폐렴에서 저용량 하이드로코르티손 주입의 효과

김호철 ( Ho Cheol Kim ),이승준 ( Seung Jun Lee ),함현석 ( Hyoun Seok Ham ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.4

배경 : 중증 지역사회 획득 폐렴은 항생제의 발달과 보조요법의 발전에도 불구하고 사망률이 높은 질환으로 호흡부전으로 진행되어 기계환기가 필요한 경우 사망률은 더욱 증가하게 된다. 최근 중증 지역사회 획득 폐렴에서 저용량 하이드로코르티손 주입이 사망률을 감소시킨다고 보고되었다. 본 연구는 기계환기가 요구된 중증 지역사회 획득 폐렴 환자에서 하이드로코르티손 정주의 효과를 알아보기 위하여 시행하였다. 방법 : 2005년 2월부터 7월까지 중증 지역사회 획득 폐렴으로 기계환기를 유지한 13명의 환자(남:여=10:3, 평균 연령: 68.6±14.1)를 대상으로 하이드로코르티손을 240mg을 부하로 정주하고 시간당 10mg을 지속적으로 7일간 주입하였다. 대조군은 연구 기간 이전 중증 지역사회 획득 폐렴으로 기계환기를 유지하고 스테로이드 치료를 하지 않았던 13명의 환자를 대상으로 하였다. 하이드로코르티손 주입 전과 주입 8일째 두 군 간의 임상적, 생리적 지표의 차이와 최종결과를 비교하였다. 결과 : 1) 하이드로코르티손 주입 전 주입군과 대조군의 나이, 성별, 내원 당시의 SAPS II, SOFA 점수, 체온, 백혈구 수, PaO2/FiO2(P/F) 비, P/F 200이 하인 환자수, 흉부방사선 사진 점수, 폐손상 점수, 카테콜라민 의존성 패혈성 쇽의 빈도 등은 유의한 차이가 없었다. 2) 하이드로코르티손 주입 8일 후 대조군에 비해 주입군이 P/F비가 100이상 호전된 환자의 비율과 흉부 방사선 점수가 호전된 환자의 비율이 유의하게 높았다(61.5% vs. 15.4% p=0.016, 76.9%vs. 23.1% p<0.05). 이외 다른 임상적 및 생리적 지표들은 주입군과 대조군 사이에 유의한 차이는 없었다. 3) 두 군 간에 기계환기 유지기간, 중환자실 재원기간, 병원내 재원기간, 재원 10일째와 30일째의 사망률은 유의한 차이가 없었다. 결론 : 기계환기가 요구되는 중증 지역사회 획득 폐렴에서 하이드로코르티손 정주는 산소화와 흉부 방사선 점수의 빠른 호전을 보이지만 최종 치료 성적에 대해서는 많은 환자를 대상으로 한 전향적 무작위 대조 연구가 필요할 것으로 사료된다. Background : Severe community-acquired pneumonia (CAP) can develop into respiratory failure that requires mechanical ventilation (MV), which is associated with a higher rate of mortality. It was recently reported that a hydrocortisone infusion in severe CAP patients was associated with a significant reduction in the length of the hospital stay and mortality. This study evaluated efficacy of a hydrocortisone infusion for patients with severe CAP requiring MV. Methods : From February 2005 to July 2005, 13 patients (M:F=10:3, mean age: 68.6±14.1 years), who were diagnosed with severe CAP and required MV, were enrolled in this study. Hydrocortisone was administered as an intravenous 200mg loading bolus, which was followed by an infusion at a rate of 10mg/hour for 7 days. The control group was comprised of patients with severe CAP requiring MV but in whom corticosteroid was not used before study period. The clinical and physiologic parameters on or by day 8 and the outcome in the hydrocortisone infusion group were compared with those in the control group. Results : 1) There was no significant difference in age, gender ratio, SAPS II, SOFA score, temperature, leukocyte count, PaO2/FiO2 (P/F) ratio, the number of patients with P/F ratio < 200, chest radiograph score, lung injury score and catecholamine-dependent septic shock between the hydrocortisone infusion group and control group at day 1. 2) At day 8, the proportion of patients with an improvement in the P/F ratio ≥ 100 and the chest radiograph score was significantly higher in the hydrocortisone infusion group than in the control group (61.5% vs. 15.4%, 76.9% vs. 23.1%, p<0.05). However, there was no significant difference in the other clinical and physiologic parameters. 3). There was no significant difference in the duration of the MV, ICU stay, hospital stay and 10th and 30th day mortality between the two groups. Conclusion : Hydrocortisone infusion for patients with severe CAP requiring invasive mechanical ventilation may be effective in improving the level of oxygenation and the chest radiograph score. (Tuberc Respir Dis 2006; 60: 419-425)